Provider Demographics
NPI:1528586856
Name:NGOTHO, ALICE VUGUTSA
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:VUGUTSA
Last Name:NGOTHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7204 BECKETT FIELD LN
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3446
Mailing Address - Country:US
Mailing Address - Phone:559-410-6699
Mailing Address - Fax:
Practice Address - Street 1:7204 BECKETT FIELD LN
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-3446
Practice Address - Country:US
Practice Address - Phone:559-410-6699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95038286163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse